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Texas House Bill 2002: Revolutionizing Healthcare Affordability

As individuals confront the complex world of healthcare, many find themselves playing financial hopscotch over deductibles and navigating the tightrope of out-of-pocket limits, not to mention the costs of essential health care services.

But what if there was a way to incentivize cost-saving behavior while simultaneously enhancing healthcare affordability and accessibility? Enter Texas H.B. 2002, passed unanimously during a public hearing in 2023.

The Dawn of a New Era: H.B. 2002 Unveiled 

Amending current law, Texas H.B. 2002, introduced a groundbreaking provision that allows individuals to credit out-of-pocket cash payments for out-of-network  medically necessary services and supplies towards their deductible and maximum out-of-pocket expenses. This revolutionary measure introduced by the House Health Care Reform Select Committee, extends a lifeline to consumers, empowering them to make informed decisions regarding their medical care while alleviating the burden of exorbitant out-of-pocket costs.

Getting Even Further into the Specifics

Beginning with fully insured policies effective on or after January 1, 2024, H.B. 2002 mandates insurers to credit any out-of-pocket payments made directly to a physician or healthcare provider for covered medical or health services towards an insured’s deductible and annual maximum out-of-pocket expenses covered by a PPO health plan. 

In addition, this legislative session tasked insurers with establishing a streamlined procedure for individuals to claim these credits in line with the Texas Department of Insurance’s rules. Insurers are also required to make sure that all necessary documentation to support such claims is readily accessible to policyholders on their respective online platforms. Consumers should check carrier websites to see about carrier forms. (We don’t think they are inclined to send out a Public Service Announcement on this!! Shocking.)

Side Bar: What does this mean for Texans?

Start with the Texas Two Step:

  1. You have to find out if your plan is fully insured or self-insured/level-funded.  Eligibility of a person is ONLY based on having a fully insured plan.

  2. You have to be covered under a PPO plan, not an HMO plan.

Then, do your homework and use the tools available to you. 

  1. Make sure the service(s) you seek are covered by your health benefit plans.  If it’s not covered in-network, it won’t be covered out-of-network. 

  2. Use the price shopping tools provided by your insurance.  You can even call your insurance and see what it would cost to go in-network for your upcoming service. When talking or searching, try to get CPT and/or diagnostic insurance codes! This is what your insurance will use to see if it’s covered and, if it is, the “average discounted rate” they would have paid for an in-network service.

Next, call your provider and negotiate a cash price up-front. Try something like this: 

  • “Hi, Dr. I really want to continue seeing you but you're out of my plan’s network. I saw that my insurance would cover a routine visit (CPT 99211) as an established patient for $325 if you were in my network. Since you’re not, can I offer you $320 cash?

Practical Tip: The provision applies when your bill is not sent to the insurance company, and the amount you paid to the doctor or healthcare provider is lower than what your insurance company usually pays to their preferred providers for the same service or item. That is a big deal! Now, you are able to navigate the landscape with greater ease and financial prudence.

Embracing the Future: The Impact of H.B. 2022

The implications of this legislation go beyond mere text, serving as a catalyst for enhancing healthcare affordability and accessibility. By incentivizing individuals to seek out cost-effective alternatives and facilitating greater transparency in healthcare pricing, the bill encourages informed decision-making and financial prudence among healthcare consumers. This in turn fosters a healthcare ecosystem characterized by improved patient satisfaction, bolstered consumer choice, and enhanced  well-being.

Looking Ahead: Implementation and Beyond

On January 1st 2024, H.B 2002 came into effect. The collaboration and active engagement of insurers, healthcare providers and, most importantly, individuals is paramount to harness the full potential of this transformative legislation. With ever-increasing healthcare costs, especially felt by our small and mid-size fully insured  employer-sponsored health insurance, H.B 2002 has been applauded as a beacon of  opportunity for other states to consider ways to affirmatively assist consumers at the point of sale.

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